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Chain of custody record with sampling and analysis fields

Machine-extracted title · confidence 95%

Record detailing the chain of custody including specific sampling and analysis instructions for the Westchester County laboratory.

NYC-WTC_000070896–000070899

Folder label: “28758

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Scanned page image, NYC-WTC_000070898
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NYC 9/11 Public Portal Document ;...................

ENVIRONMENTAL SERVICES SAMPLE SUBMISSION FORM WESTCHESTER COUNTY LABORATORIES AND RESEARCH 2 Dana Road, Valhalla, New York 10595 H (914) 593-5575 NYS-ELAPNo. 10108 — Time/Date Set:_________ Form A-70 (rev, 1/96) Sample Type (circle one): J 02. Non-Potable 3. Non-Potable Treated 4. Other_____________ Bottle Chain of Custody? .yes no Time/Date Collected:. -------- Comments: Collected By: aA .A <Zt9i I Agency Code: PWS #:_________ Source ID: Type Descriptor: Collected From: Bill to: Location’s/lndividual’s Name Name/Company Street______________________ Street__________ City/SVZip__________________ City/St/Zip Identification of Source Phone#: __Fax #:, Collection I CA, CH, Bl? Check#: Amounts,

BACTERIOLOGICAL ANALYSES ORGANIC POTABLE ANALYSES ORGANIC NONPOTABLE/SOLID ANALYSES Lab#:______________________ Lab #:____________ -‘A / ~ / (circle tests) (circle tests) / / j 1. Heterotrophic Plate J. J Trihalomethanes (524) t 1. Purgeable Halocarbons (624/8260) Count (hemodialysis & all others) Volatile Halocarbons (524) 2. Purgeable Aromatics (624/8260) 2. Coliform P/A (public supplies) Volatile Aromatics (524) 3. Acrolein & Acrylonitrile (624) 3. Coliform MPN (priv well, raw, stp) 4. Total Trihalomethane Potential (510) 4. Phthalates (606/8060) 4. Fecal Coliform (all samples) 5. Microextractables (504) • 5. Organochlorine Pesticides (608/8080) 5. Microscopic 6. Pesticides (507) 6. PCB's (Arochlors) (608/8080) 6. Macroscopic 7. Pesticides/PCB screen (508) 7. Herbicides (SM-18/6640; 8151) 7. API '' - 8. PCB as Decachlorobiphenyl (5b8A) 8. ' Other Pesticides.(SM-18/6630) 8. Other:___________________ 9. Herbicides (515) 9. Petroleum Hydrocarbon Scan (310-13) 10. Pesticides (525) ,10. Glycols in Water Refrigerated? ,yes. no 11. Carbamate Pesticides (531) 11. Acid Extractables (625/8270) 12. Glyphosate (547) 1i&Base Neutral Extractables (625/8270) Chlorinated?: .yes. .no 13. Diquat (549) ^^GC/MS Unknown Scan . 14. Chlorination Disinfection Byproducts (551) 14. Purgeable Halocarbons (DEF) Free Chlorine Res:- mg/L 15. Haloacetic Acids (552) < ,15. Purgeable Aromatics (DEF) 16. Other Pesticides (SM-18/6630) ■■ 16. Pesticides (DEF)? Total Chlorine Res: -Htg/L 17. Petroleum/Hydrocarbon Scan (31.0-13) . 17. PCB’s (Arochlors) (DEF)

pH,

INORGANIC ANALYSES REQUESTED - Lab#: (circle tests) 1. Color 20. Acidity ’391Aluminum 59 Potassium / 2. Turbidity 21. Alkalinity, as CaCOa 40. intimony /€o?Belenium 3. pH 22. Bromide 41. irsenic |6l/siiver 4. Conductivity 23. Bromate/Chlorate/Chlorite 42. larium ez Sodium 5. Corrosivity (temp: .’C) 24. Chloride 43> teryllium Thallium 6. BOD (5 day) 25. Cyanide 44. Boron W' Vanadium 7. Soluble BOD (5 day) 26. Fluoride 45. Cadmium 65?'Zinc__________ 8. Carbonaceous BOD (5 day) 27. Hardness, Total as CaCOa 46. Calcium, as CaCOa CtP 9. Chemical Oxygen Demand 28. Nitrogen, Ammonia as N 47. Calcium, Ca*^ 66. Metals/CN 10. Dissolved Oxygen 29. Nitrogen, Nitrate as N .48',Chromium, Total 67. Volatiles Ji. Total Organic Carbon 30. Nitrogen, Nitrite as N 49. Chromium, Hexavalent 68. Semi-volatiles 12. Total Organic Halides 31. Nitrogen, Total Kjeldahl as N /ta Cobalt 69. Pesticides/PCB's 13. Solids, Percent (%) 32. Oil and Grease / SlJCopper 70. Disk Deliverables ! 52.|lron 14. Solids, Settleable 33. Phenol ISLE 15. Solids, Suspended 34. Phosphorus. Total as P \^Lead 71. TCLP-Metals 16. Solids. Total 35. Phosphorus. Ortho as P ^^.Magnesium 72. TCLP-Pesticides 17. Solids. Total Dissolved 36. Sulfates /Ss.lManganese 73. TCLP-Herbicides 18. Solids. Total Volatile 37. Surfactants / 56.^ercury' 74. TCLP-Volatiles ® Other: A. 38. IIV254 I 57.jMolybdenum 75. TCLP-BNA's Xss/Nickel ' -------------------------

NYC-WTC_000070898

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NYC-WTC_000070898Source: NYC Law Department, mirrored locally

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